Succession Planning for ASCs (February 20, 2023)




In this episode of the Advancing Surgical Care Podcast, ASCA Chief Executive Officer Bill Prentice talks with ASCA Board Member Lisa Austin, RN, CASC, about succession planning for ASCs. Austin, an ASC development and operations expert, is a member of the ASCA Board of Directors, a past president of the Colorado Ambulatory Surgery Center Association, a registered nurse and a CASC-certified administrator. This short, highly informative program offers valuable insights regarding the inevitable need to respond to leadership transitions in both facility management and physician partners. Austin’s strategies and advice apply equally to both independent ASCs and centers affiliated with a management company.

Narrator:   0:06
Welcome to the Advancing Surgical Care Podcast brought to you by ASCA, the Ambulatory Surgery Center Association. ASCA represents the interests of outpatient surgery centers of every specialty and provides advocacy and resources to assist them in delivering safe, high-quality, cost-effective patient care. As with all of ASCA’s communications, please check to make sure you are listening to or viewing our most up-to-date podcasts and announcements.

Bill Prentice:   0:37
Hello, and welcome to the Advancing Surgical Care Podcast brought to you by the Ambulatory Surgery Center Association, or ASCA. My name is Bill Prentice, and I’m ASCA’s CEO and the host of this episode. In a moment, I will be joined by my guest, Lisa Austin, for a discussion about succession planning in ASCs. As every ASC administrator knows, recruiting and retaining professional medical personnel has never been easy, and it was even more difficult as a result of the COVID 19 pandemic. When you add the challenge of also recruiting a new administrator or new physician owner or owners who need to possess entrepreneurial and business skills in addition to being medically qualified, that dynamic becomes even more complex. And while the need for this type of planning is especially important for independent ASCs, nearly identical challenges exist for corporate-owned and partnered ASCs. Gratefully, Lisa Austin has helped many ASCs meet this challenge and she’s agreed to share some of her experience and insights with me today. Lisa has developed numerous surgery centers in concert with investors, corporations, hospitals, architects, builders and manufacturers through all phases of surgery center development and management. Lisa is a member of the ASCA Board of Directors, a past president of the Colorado Ambulatory Surgery Center Association, a registered nurse and a CASC-certified administrator. Lisa, welcome to the podcast.

Lisa Austin:   2:01
Thank you, Bill.

Bill Prentice:   2:02
So, Lisa, succession planning can be a difficult subject for some organizations and cause a lot of anxiety both in the ranks and at the top of an organization. I’ve noticed that a lot of big, successful companies are very open about their succession planning, even years in advance of anticipated retirements. Others are clearly very tight lipped and discreet. Since ASCs are generally small organizations with very few secrets among the staff, what do you recommend in terms of that approach?

Lisa Austin:   2:30
I think people need to communicate their needs and desires. People, especially administrators, like to not make those kinds of announcements: I’m going to retire in two years, I’m going to retire in three years. But we know that as people mature in the marketplace, in the workforce, that that is going to happen. So, I think that there should be succession planning—it should be written, it should be very strategic and there should be a set of objectives to be met—because there will be a time period for that to happen and the recruitment process is really, really tight right now.

Bill Prentice:   3:09
When you talk about being kind of open about that process, are you talking to like the surgeon owners? Or are you also talking to the staff at large? Is there a different timeframe, different decision for each of those instances?

Lisa Austin:   3:20
All of the above. The difference with the physician investors is trying to create a plan for them to help the younger physicians just getting out of residency come into the ownership situation, and we have a lot of nuances with that in terms of those doctors usually come with a lot of debt. And so, it’s very hard for those to come into an existing center because the cost per share is so high or even a new center. So, with that financial investment, the more mature surgeons and investors need to help develop some creative financing plans to help them so that that legacy of the surgery center can go on. When you’re looking at the administrator, the clinical manager, the business manager, those people are much harder to come by and so there may be a period of long-term mentoring and coaching that needs to occur. So, I think that it needs to be discussed. Physicians need to be involved with the plan for the administrator or other leadership within the facility. But I think that it needs to be discussed and it needs to be talked about sooner than later.

Bill Prentice:   4:29
So, when you start to work with an ASC on its succession planning, I know that one of the first steps you urge clients to take is an evaluation of their current staff for future leadership potential. You kind of just touched on this about mentoring and seeing if there’s someone on the current staff that can take that step up to that next higher level position before they look outside the facility or the organization. And this type of evaluation can be very subjective at times, I imagine. So, are there some objective or empirical measures that you also urge clients to consider when evaluating either administrative or medical staff?

Lisa Austin:   5:06
Yes. First, I’ll say that subjective seems to be the best tool that we often have, whether it’s to be my subjective view of an individual or even their subjective view of themselves, because I like to query them, and for people to do self-assessments as part of their routine annual evaluations, so that you can start determining what some of their skill levels are—if it’s they’re really good with communication, they take charge in a leadership situation, they can think outside the box, their emotional intelligence is very high on the scale. But there’s also outside coaching services, professional services, that you can use to get some of that empirical data that really will help make a decision going forward.

Bill Prentice:   5:52
And so that would be really important if you really wanted to create a culture in the facility of growing your own leaders, and turning nurses into directors of nursing, and directors of nursing potentially into administrators, that that’s the type of work that you think surgery centers need to be mindful of today.

Lisa Austin:   6:09
It’s something—it’s one thing that they need to be mindful of today. It’s also trying to evaluate, “Am I just choosing this person because it’s the easiest way, and I’m going to make them be something whether I think that they can really be that person to succeed? Or because we do everything the same way all the time?” I think that now in the world that we live in, we may need to concurrently look outside, and it may be even outside our own profession, to ensure that we get the right people to come in and carry this business forward.

Bill Prentice:   6:45
So, if or when an organization determines they need to look outside of their ranks for future management or leadership, what advice do you give in terms of conducting a search? For example, on the one hand, the search process can be very time consuming and maybe beyond the skill set of the people being tasked with conducting it within the facility. On the other hand, searches for highly compensated individuals can also be very expensive. So, what’s your advice for that aspect?

Lisa Austin:   7:13
What I think today has changed from what I thought maybe five years ago. I think that an executive search is very important because you need to not look at what’s in your neighborhood or in your building to get the right person. So, tasking a firm with taking all of the qualities that you’re looking for to bring ongoing continued success to your ASC, I think that they have the ability to look further and deeper than what you can do as an individual. Now, with that said, if we’ve identified people in our community, in the center, then that makes the most sense. We want to offer people the opportunity to move up within the organization. But we shouldn’t pigeonhole ourselves to doing that because that’s what we’ve always done or that seems like the easiest way to go.

Bill Prentice:   8:04
Right. And I imagine that 20 years ago, it was probably much more likely that a physician owner would say, “Oh, I know this person over here in the hospital and she’d be great.” Or, “He’d be really good at doing this, let’s just do that.” As the ASC models become bigger and more complex, that’s probably not the right approach in most circumstances, that taking a more professional approach and casting a wider net is probably the best way for a surgery center to find the right person for the job. Is that right?

Lisa Austin:   8:32
Exactly. However, that is still going on. “I know this nurse over at the hospital, I think she would be a great administrator,” and this person has no business background or has really no desire than to just be back circulating with the surgeon.

Bill Prentice:   8:47
Right. Good to be mindful of that. So, Lisa, as you know, ASCA has started an ASC Administrator Development Program for new and aspiring ASC administrators that provides both, I think, valuable education and training, but also pairs the participants in the program with a seasoned and experienced administrator mentor. The program has been enormously popular in its first year with both the course enrollees and the volunteer mentors, both giving us great feedback for the program. And it certainly demonstrates there’s a demand for this type of education and training at the administrative level. Are there other resources you can recommend to our listeners?

Lisa Austin:   9:24
Well, my number one resource would be the ASCA program because it is so thorough and it’s people who already have some knowledge of our industry. However, I love the concept of being able to offer employees outside coaching, that professional coaching. I’ve experienced that myself, and at a more mature age I wish I would have had that 20 years ago. And so, I think that surgery centers need to invest in our employees and we need to pay for education; we need to pay for people to improve upon their already great skills and maybe develop some of those skills that are not as strong.

Bill Prentice:   10:05
I think that’s really, really important. And albeit it might be a little self-serving for me to say, but I think the education and training that ASCA puts on throughout the year, whether it’s our webinars, our seminars or our annual conference, provides awesome opportunities on a host of issues and a range of responsibilities to get that type of education and training that’s going to lead to a more efficient, better run surgery center. And I hope that your words get in the years of more surgeon owners and they understand the value of investing in their employees because the return on that for the surgery center can be enormous.

Lisa Austin:   10:39
It’s huge. And a lot of times people are always looking at the bottom line and they say we can’t afford this education. Well, you want a good business office manager? You want your administrators to get continuing education and become certified? Send them to ASCA.

Bill Prentice:   10:54
Right. Well, from your mouth to God’s ears, Lisa. So, Lisa, I want to thank you for sharing your time and expertise with us today. And thank you also for the great work you’ve done as a member of the ASCA Board. Your participation has been invaluable and we’re all very grateful for it.

Lisa Austin:   11:10
Thank you.

Bill Prentice:   11:11
So once again, if anyone listening has additional questions, please don’t hesitate to contact us or visit the ASCA website, where more details on the ASC Administrator Development Program can be found.